<!DOCTYPE html>



  


<html class="theme-next pisces use-motion" lang="zh-Hans">
<head>
  <meta charset="UTF-8"/>
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1"/>
<meta name="theme-color" content="#222">


<meta name="google-site-verification" content="E9deYnivN5MuHMuIfiMZZfS0alv-d_0UjcwjBL79lGU" />



<meta name="baidu-site-verification" content="iHYWJxscwD" />










<meta http-equiv="Cache-Control" content="no-transform" />
<meta http-equiv="Cache-Control" content="no-siteapp" />



  <meta name="google-site-verification" content="true" />








  <meta name="baidu-site-verification" content="true" />







  
  
  <link href="/lib/fancybox/source/jquery.fancybox.css?v=2.1.5" rel="stylesheet" type="text/css" />







<link href="/lib/font-awesome/css/font-awesome.min.css?v=4.6.2" rel="stylesheet" type="text/css" />

<link href="/css/main.css?v=5.1.4" rel="stylesheet" type="text/css" />


  <link rel="apple-touch-icon" sizes="180x180" href="/images/apple-touch-icon-next.png?v=5.1.4">


  <link rel="icon" type="image/png" sizes="32x32" href="/images/favicon-32x32-next.png?v=5.1.4">


  <link rel="icon" type="image/png" sizes="16x16" href="/images/favicon-16x16-next.png?v=5.1.4">


  <link rel="mask-icon" href="/images/logo.svg?v=5.1.4" color="#222">





  <meta name="keywords" content="周锐,2019锐读会,笔记,网络学习,牙齿美白,内漂白,个别牙变色,微研磨," />










<meta name="description" content="直播时间：20190906第三章：内漂白的适应症和禁忌症1.适应症a.牙髓腔来源的变色b.牙本质变色c.冠外漂白无效的牙齿变色（单独四环素牙并不是牙髓失活根管治疗的适应症。）d.已行完善根管治疗2.禁忌症a.釉质形成缺陷（没有形成屏障，造成牙龈损伤）b.表浅釉质变色及龋坏c.严重丧失牙本质（腔大壁薄的牙齿）d.复合树脂变色。第四章 内漂白的安全建议和副作用1.安全建议a.有效隔离患牙保护口腔黏膜b">
<meta property="og:type" content="article">
<meta property="og:title" content="013.2019新锐读会 课程笔记《牙齿美白技术》05">
<meta property="og:url" content="https://zwdnet.github.io/2019/09/08/013-2019%E6%96%B0%E9%94%90%E8%AF%BB%E4%BC%9A-%E8%AF%BE%E7%A8%8B%E7%AC%94%E8%AE%B0%E3%80%8A%E7%89%99%E9%BD%BF%E7%BE%8E%E7%99%BD%E6%8A%80%E6%9C%AF%E3%80%8B05/index.html">
<meta property="og:site_name" content="赵瑜敏的口腔医学专业学习博客">
<meta property="og:description" content="直播时间：20190906第三章：内漂白的适应症和禁忌症1.适应症a.牙髓腔来源的变色b.牙本质变色c.冠外漂白无效的牙齿变色（单独四环素牙并不是牙髓失活根管治疗的适应症。）d.已行完善根管治疗2.禁忌症a.釉质形成缺陷（没有形成屏障，造成牙龈损伤）b.表浅釉质变色及龋坏c.严重丧失牙本质（腔大壁薄的牙齿）d.复合树脂变色。第四章 内漂白的安全建议和副作用1.安全建议a.有效隔离患牙保护口腔黏膜b">
<meta property="og:locale">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/01.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/02.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/03.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/04.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/05.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/06.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/07.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/08.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/09.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/10.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/11.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/12.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/13.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/14.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/15.png">
<meta property="og:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg">
<meta property="article:published_time" content="2019-09-08T03:41:55.000Z">
<meta property="article:modified_time" content="2020-08-30T05:52:03.000Z">
<meta property="article:author" content="赵瑜敏">
<meta property="article:tag" content="周锐">
<meta property="article:tag" content="2019锐读会">
<meta property="article:tag" content="笔记">
<meta property="article:tag" content="网络学习">
<meta property="article:tag" content="牙齿美白">
<meta property="article:tag" content="内漂白">
<meta property="article:tag" content="个别牙变色">
<meta property="article:tag" content="微研磨">
<meta name="twitter:card" content="summary">
<meta name="twitter:image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/01.png">



<script type="text/javascript" id="hexo.configurations">
  var NexT = window.NexT || {};
  var CONFIG = {
    root: '',
    scheme: 'Pisces',
    version: '5.1.4',
    sidebar: {"position":"left","display":"post","offset":12,"b2t":false,"scrollpercent":false,"onmobile":false},
    fancybox: true,
    tabs: true,
    motion: {"enable":true,"async":false,"transition":{"post_block":"fadeIn","post_header":"slideDownIn","post_body":"slideDownIn","coll_header":"slideLeftIn","sidebar":"slideUpIn"}},
    duoshuo: {
      userId: '0',
      author: '博主'
    },
    algolia: {
      applicationID: '',
      apiKey: '',
      indexName: '',
      hits: {"per_page":10},
      labels: {"input_placeholder":"Search for Posts","hits_empty":"We didn't find any results for the search: ${query}","hits_stats":"${hits} results found in ${time} ms"}
    }
  };
</script>



  <link rel="canonical" href="https://zwdnet.github.io/2019/09/08/013-2019新锐读会-课程笔记《牙齿美白技术》05/"/>





  <title>013.2019新锐读会 课程笔记《牙齿美白技术》05 | 赵瑜敏的口腔医学专业学习博客</title>
  








<meta name="generator" content="Hexo 5.4.0"></head>

<body itemscope itemtype="http://schema.org/WebPage" lang="zh-Hans">

  
  
    
  

  <div class="container sidebar-position-left page-post-detail">
    <div class="headband"></div>

    <header id="header" class="header" itemscope itemtype="http://schema.org/WPHeader">
      <div class="header-inner"><div class="site-brand-wrapper">
  <div class="site-meta ">
    

    <div class="custom-logo-site-title">
      <a href="/"  class="brand" rel="start">
        <span class="logo-line-before"><i></i></span>
        <span class="site-title">赵瑜敏的口腔医学专业学习博客</span>
        <span class="logo-line-after"><i></i></span>
      </a>
    </div>
      
        <p class="site-subtitle"></p>
      
  </div>

  <div class="site-nav-toggle">
    <button>
      <span class="btn-bar"></span>
      <span class="btn-bar"></span>
      <span class="btn-bar"></span>
    </button>
  </div>
</div>

<nav class="site-nav">
  

  
    <ul id="menu" class="menu">
      
        
        <li class="menu-item menu-item-home">
          <a href="/%20" rel="section">
            
              <i class="menu-item-icon fa fa-fw fa-home"></i> <br />
            
            首页
          </a>
        </li>
      
        
        <li class="menu-item menu-item-tags">
          <a href="/tags/%20" rel="section">
            
              <i class="menu-item-icon fa fa-fw fa-tags"></i> <br />
            
            标签
          </a>
        </li>
      
        
        <li class="menu-item menu-item-categories">
          <a href="/categories/%20" rel="section">
            
              <i class="menu-item-icon fa fa-fw fa-th"></i> <br />
            
            分类
          </a>
        </li>
      
        
        <li class="menu-item menu-item-archives">
          <a href="/archives/%20" rel="section">
            
              <i class="menu-item-icon fa fa-fw fa-archive"></i> <br />
            
            归档
          </a>
        </li>
      

      
    </ul>
  

  
</nav>



 </div>
    </header>

    <main id="main" class="main">
      <div class="main-inner">
        <div class="content-wrap">
          <div id="content" class="content">
            

  <div id="posts" class="posts-expand">
    

  

  
  
  

  <article class="post post-type-normal" itemscope itemtype="http://schema.org/Article">
  
  
  
  <div class="post-block">
    <link itemprop="mainEntityOfPage" href="https://zwdnet.github.io/2019/09/08/013-2019%E6%96%B0%E9%94%90%E8%AF%BB%E4%BC%9A-%E8%AF%BE%E7%A8%8B%E7%AC%94%E8%AE%B0%E3%80%8A%E7%89%99%E9%BD%BF%E7%BE%8E%E7%99%BD%E6%8A%80%E6%9C%AF%E3%80%8B05/">

    <span hidden itemprop="author" itemscope itemtype="http://schema.org/Person">
      <meta itemprop="name" content="">
      <meta itemprop="description" content="">
      <meta itemprop="image" content="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/tx.jpg">
    </span>

    <span hidden itemprop="publisher" itemscope itemtype="http://schema.org/Organization">
      <meta itemprop="name" content="赵瑜敏的口腔医学专业学习博客">
    </span>

    
      <header class="post-header">

        
        
          <h1 class="post-title" itemprop="name headline">013.2019新锐读会 课程笔记《牙齿美白技术》05</h1>
        

        <div class="post-meta">
          <span class="post-time">
            
              <span class="post-meta-item-icon">
                <i class="fa fa-calendar-o"></i>
              </span>
              
                <span class="post-meta-item-text">发表于</span>
              
              <time title="创建于" itemprop="dateCreated datePublished" datetime="2019-09-08T03:41:55+00:00">
                2019-09-08
              </time>
            

            

            
          </span>

          
            <span class="post-category" >
            
              <span class="post-meta-divider">|</span>
            
              <span class="post-meta-item-icon">
                <i class="fa fa-folder-o"></i>
              </span>
              
                <span class="post-meta-item-text">分类于</span>
              
              
                <span itemprop="about" itemscope itemtype="http://schema.org/Thing">
                  <a href="/categories/2019%E9%94%90%E8%AF%BB%E4%BC%9A/" itemprop="url" rel="index">
                    <span itemprop="name">2019锐读会</span>
                  </a>
                </span>

                
                
              
            </span>
          

          
            
          

          
          

          

          
            <div class="post-wordcount">
              
                
                  <span class="post-meta-divider">|</span>
                
                <span class="post-meta-item-icon">
                  <i class="fa fa-file-word-o"></i>
                </span>
                
                  <span class="post-meta-item-text">字数统计&#58;</span>
                
                <span title="字数统计">
                  3k
                </span>
              

              
                <span class="post-meta-divider">|</span>
              

              
                <span class="post-meta-item-icon">
                  <i class="fa fa-clock-o"></i>
                </span>
                
                  <span class="post-meta-item-text">阅读时长 &asymp;</span>
                
                <span title="阅读时长">
                  10
                </span>
              
            </div>
          

          

        </div>
      </header>
    

    
    
    
    <div class="post-body" itemprop="articleBody">

      
      

      
        <p>直播时间：20190906<br>第三章：内漂白的适应症和禁忌症<br>1.适应症<br>a.牙髓腔来源的变色<br>b.牙本质变色<br>c.冠外漂白无效的牙齿变色（单独四环素牙并不是牙髓失活根管治疗的适应症。）<br>d.已行完善根管治疗<br>2.禁忌症<br>a.釉质形成缺陷（没有形成屏障，造成牙龈损伤）<br>b.表浅釉质变色及龋坏<br>c.严重丧失牙本质（腔大壁薄的牙齿）<br>d.复合树脂变色。<br>第四章 内漂白的安全建议和副作用<br>1.安全建议<br>a.有效隔离患牙保护口腔黏膜<br>b.确认根管充填完善<br>c.制备保护屏障<br>d.避免酸蚀避免加热<br>e.避免使用强氧化剂<br>2.副作用及并发症<br>a.牙根外吸收（化学物质通过未保护的牙本质小管和骨质）<br>b.热、细菌、外伤是促进因素（内漂白不建议加热的原因）<br>c.化学烧伤（注意防护）<br>d.影响粘接（增加树脂的孔隙率聚合不全）<br>第五章 四环素牙的意向性牙髓治疗及内漂白技术<br>a.严重四环素活髓牙牙髓治疗后漂白有效<br>b.这种方式不被今天的理论接受<br>c.目前建议家庭漂白。<br>第六章 死髓牙内漂白技术的治疗计划核查清单<br>《清单革命》<br>1.根管治疗质量如何？良好/可接受/不佳<br>2.是否存在根尖周病变？<br>3.患者是或否存在主观症状？<br><strong>4.临床检查是否发现裂纹？</strong><br>5.临床冠及釉质是否充分可供内漂白？<br>6.是否需要进一步修复治疗？(如要打桩，屏障层要取出，否则不用取出）<br>7.邻牙颜色如何？（单独漂白一颗，很难与邻牙颜色一致。内漂白+诊室/家庭漂白）<br>8.牙颈部颜色如何？（如果颈部颜色变暗，必须屏障到CEJ）<br>9.笑线？高/低？<br>第十部分：活髓牙单颗牙漂白技术<br>第一章：病史和诊断及变色过程<br>病史和诊断：<br>a.患者曾受到某种程度的轻微外伤（单个牙齿）<br>b.患者经常忘记复诊时记起<br>变色过程：<br>a.牙齿外伤内部出血<br>b.自身防御产生继发牙本质和三期牙本质<br>c.髓腔减小或闭锁血液分解释放铁与硫化氢生成硫化铁。<br>d.活髓或者死髓颜色黑或黑褐色或黄色。<br>第二章：牙髓活力测试和影像学评估<br>牙髓活力测试：<br>a.通常为活髓但髓腔变小<br>b.电活力测试迟缓往往达到最高值<br>c.冷热测也类似<br>影像学评估<br>a. 根尖片观察钙化或堵塞<br>b.无折断变现常无根尖周病变<br>c.牙根完整无内吸收和外吸收<br>d.有时可见中间模糊影像或牙本质桥<br>第三章：病理过程及钙化变性发病率<br>1.病理过程<br>a.外伤-牙髓出血-继发牙本质形成<br>b.髓腔钙化变性(Calcific metamorphosis, CM)<br>c.组织学上牙髓胶原含量增加细胞体积增大<br>2.目前研究：<br>a.没有理由对这些牙齿根管治疗<br>b.20年的研究只有13%-16%出现根尖周病变<br>c.后期出现的根尖周病变与龋坏不良修复或再次外伤有关<br>3.CM发病率：<br>a.3.8%-24%外伤牙出现CM<br>b.CM牙齿中1-1.6%会发生牙髓坏死<br>c.CM中出现根尖周病变-治疗<br>第四章：单科牙及全牙列美白流程和随访<br>治疗方案1：先漂白变色牙再整体美白<br>a.先制作标准托盘2个<br>b.将其中一个标准托盘修改（去除变色牙的邻牙）<br>c.单独漂白变色牙齿（16-22%CP）<br>d.颜色变化后再整体美白（10%CP）<br>治疗方案2：只美白变色牙齿<br>a.先制作标准托盘1个<br>b.将标准托盘修改（去掉变色牙齿的邻牙）<br>c.单独漂白变色牙齿（16-22%CP）<br>d.很难将颜色调改成一致于邻牙<br>治疗方案3：先整体美白再漂白变色牙齿<br>a.先制作标准托盘2个<br>b.将其中一个标准托盘修改（去除变色牙的邻牙）<br>c.先整体美白2周（10%CP）<br>d.在单独漂白变色牙齿4-6周（16-22%CP）<br>随访和监测：应定期复诊评估治疗进展<br>a.通常每2周复诊<br>b.年龄较大的可3周复诊（这类患者牙齿美白较暗）<br>c.达到满意后建议过漂1-2个色阶<br>d.3年后建议润色美白一次<br>（小结：个别牙变色，死髓牙，根管治疗后内漂白；活髓牙，先漂白变色牙，再整体美白，3年后复诊润色美白）<br>第十一部分：牙齿美白、微研磨和白垩斑消除。<br>第一章：白垩斑、白纹等白色病损的治疗方式<br>1.微研磨技术问世已经超过25年，国内开展的不好。<br>2.微研磨技术和美白技术结合是白垩斑有效的微创治疗。<br>3.类型、病因及可能的治疗手段<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/01.png"><br>第二章 微研磨概述<br>1.什么是微研磨<br>定义：<br>a.利用特殊的混合物<br>b.将显微级别的釉质表层<br>c.留下完整的釉质表面<br>d.治疗因矿化过度、矿化不足和着色引起的变色。<br>2.微研磨与美白的区别<br>微研磨的特点：<br>a.通过去除表层变色釉质改善牙齿颜色<br>b.去除变色后效果较稳定<br>c.牙体整体颜色无改变<br>美白特点：<br>a.氧化还原反应脱色整体变白变亮变浅<br>b.美白可保留富养的釉质表层<br>c.不改变牙齿形态可以反复多次<br>美白VS微研磨：建议先美白再微研磨<br>3.微研磨的材料选择<br>目前常用的微研磨材料（皓齿的）<br>a.6.6%盐酸Spalustre<br>b.专利套装、紫色注射器含<br>c.盐酸和二氧化硅微颗粒等组成的水溶性糊剂<br>4.白垩斑治疗的最佳年龄<br>白垩斑治疗的最佳年龄：<br>a.恒牙完全萌出后（充分理解病因后治疗）<br>b.青少年为最佳年龄（渐成熟有美观意识）<br>c.成年人和老年人也可治疗（微创保守）<br>5.微研磨记录和材料要求标准<br>微研磨的作用效果和作用机理<br>a.酸蚀研磨去除表层着色<br>b.使釉质表层重新构建成为无定形无釉柱层<br>c.临床上表现为富油光泽的美观<br>d.“釉质光釉效应”或“酸蚀磨损”效应<br>专利套装的理想要求：<br>a.应采用水溶性凝胶，易于使用<br>b.应避免溢出或喷溅的风险：应易于涂布<br>c.凝胶浓度可针对不同情况进行调整<br>d.酸浓度较低，以保证口内使用安全<br>e.研磨剂硬度充分以保证与酸联合使用时可易于去除表层釉质<br>f.研磨剂颗粒较小，避免损伤釉质<br>g.涂布方法应缓慢，避免混合物飞溅。（用根管马达就行）<br>6.微研磨的适应症和禁忌症<br>适应症<br>a.因早产牙齿发育不全，导致发育性内源性着色<br>b.发育线和变色<br>c.表浅釉质着色和不透明<br>d.黄棕色区域<br>e.多色着色（棕色、灰色或黄色）<br>f.表浅釉质发育不良（釉质发育紊乱）<br>g.氟斑牙和白垩斑<br>h.菌斑或正畸矫治器造成的表浅釉质脱矿<br>i.一些不规则表面纹理。<br>(为于釉质表层200微米以内的变色都可以使用微研磨处理）<br>禁忌症<br>a.增龄性着色<br>b.四环素牙<br>c.深层釉质发育不良<br>d.某些延伸到牙本质内的矿化不良<br>e.某些釉质发育不全<br>f.大部分牙本质发育不全<br>g.釉质区下方发生龋坏<br>h.釉质深层和牙本质变色<br>7.微研磨技术的优缺点<br>优势<br>a.易于实操<br>b.微创费用低廉<br>c.治疗后无需复杂维护<br>d.作用迅速有效<br>e.有效去除黄-棕色，白色或多色着色<br>f.效果持久<br>缺点<br>a.去除部分釉质<br>b.盐酸复合物有腐蚀性<br>c.患者、牙医和助手均应佩戴保护设备<br>d.需要前来诊室就诊。<br>第三章 微研磨的治疗过程<br>第一节 牙齿的临床评估<br>a.计划微研磨治疗时应在湿润的状态下评估牙齿（最好在美白一个疗程之后）<br>b.釉质变色存在但唾液会将其遮挡<br>c.去除釉质时尽量微创小于200μm<br>d.建议美白后（水化后评估）再去除<br>e.唾液存在时白垩斑较明显再磨除。<br>第二节 所需器械<br>研磨膏<br>根管马达<br>减速手机（转速350-500转/分）<br>专业橡皮杯<br>防护镜（盐酸有腐蚀性）<br>橡皮障<br>第三节 治疗计划<br>a.未满18岁的患者要同家长一同探讨治疗流程<br>b.讨论进一步治疗的可能（美白、树脂修复、贴面或全冠）<br>c.要保守介绍治疗结果降低期望值（不必做出保证）<br>第四节 一步一步疗程<br>1.橡皮杯抛光膏清洁牙面<br>2.橡皮障或牙龈保护剂隔离<br>3.保护口周组织<br>4.细颗粒金刚砂车针去除表层（非必要，不建议）<br>5.涂布研磨膏<br>6.使用专业研磨头（内部特殊沟槽）<br>7.加压短时间研磨（最多不超过60s）<br>8.湿棉球擦除研磨剂<br>9.加水再评估牙齿<br>10.从切端确定釉质厚度<br>11.必要时可重复上述过程<br>12.含氟抛光膏或护牙素抛光<br>13.冲洗后再次评估牙齿外观<br>14.去除橡皮障涂布护牙素1分钟<br>15.再次评估第二天改善<br>16.4-6周复诊评估结果<br>实操<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/02.png"><br>吹干，切端有黄斑<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/03.png"><br>先漂白，还存在，清洁牙面<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/04.png"><br>口内要上障，在患区挤研磨膏<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/05.png"><br>用专用毛刷来刷，加压，转速350-500，研磨15s<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/06.png"><br>去除研磨膏，冲水干燥，观察，研磨第二遍15s<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/07.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/08.png"><br>擦干，观察<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/09.png"><br>黄斑还有，再来一遍<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/10.png"><br>冲洗，吹干，观察，再来一遍（第四遍）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/11.png"><br>冲洗，吹干，观察。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/12.png"><br>放护牙素，抛光，5000转有水<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/13.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/14.png"><br>OK，结束。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/008/15.png"><br><strong>总结：个别牙变色的美白。主要就是髓腔美白，个别牙漂白，微研磨。有药物渗漏引起牙龈损伤的危险的患者不能用髓腔美白。变色超过釉质内200微米的不能用微研磨。二者都往往需要与诊室/家庭美白相结合。牙外伤往往导致髓腔钙化变性（CM），髓腔缩窄，血管破裂，血液流出，血液内的铁元素和硫化氢生成硫化铁，从而产生牙齿变色。漂白方案是先漂白变色牙(16%-22%CP），再整体对全口漂白（10%CP）。微研磨主要使用6.6%盐酸的研磨剂(查了一下物料表，有的，皓齿|Opalustre微研磨剂|氟斑牙专用套装或者皓齿|牙釉质微研磨膏），使用专用的抛光毛刷对釉质表面微研磨，磨15s观察一次，不够再磨，够了就不磨了。</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
<p><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
    </div>
    
    
    

    

    
      <div>
        <div style="padding: 10px 0; margin: 20px auto; width: 90%; text-align: center;">
  <div>欢迎打赏！感谢支持！</div>
  <button id="rewardButton" disable="enable" onclick="var qr = document.getElementById('QR'); if (qr.style.display === 'none') {qr.style.display='block';} else {qr.style.display='none'}">
    <span>打赏</span>
  </button>
  <div id="QR" style="display: none;">

    
      <div id="wechat" style="display: inline-block">
        <img id="wechat_qr" src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/mm_facetoface_collect_qrcode_1542944836634.png" alt=" 微信支付"/>
        <p>微信支付</p>
      </div>
    

    
      <div id="alipay" style="display: inline-block">
        <img id="alipay_qr" src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/1542944857770.jpg" alt=" 支付宝"/>
        <p>支付宝</p>
      </div>
    

    

  </div>
</div>

      </div>
    

    

    <footer class="post-footer">
      
        <div class="post-tags">
          
            <a href="/tags/%E5%91%A8%E9%94%90/" rel="tag"># 周锐</a>
          
            <a href="/tags/2019%E9%94%90%E8%AF%BB%E4%BC%9A/" rel="tag"># 2019锐读会</a>
          
            <a href="/tags/%E7%AC%94%E8%AE%B0/" rel="tag"># 笔记</a>
          
            <a href="/tags/%E7%BD%91%E7%BB%9C%E5%AD%A6%E4%B9%A0/" rel="tag"># 网络学习</a>
          
            <a href="/tags/%E7%89%99%E9%BD%BF%E7%BE%8E%E7%99%BD/" rel="tag"># 牙齿美白</a>
          
            <a href="/tags/%E5%86%85%E6%BC%82%E7%99%BD/" rel="tag"># 内漂白</a>
          
            <a href="/tags/%E4%B8%AA%E5%88%AB%E7%89%99%E5%8F%98%E8%89%B2/" rel="tag"># 个别牙变色</a>
          
            <a href="/tags/%E5%BE%AE%E7%A0%94%E7%A3%A8/" rel="tag"># 微研磨</a>
          
        </div>
      

      
      
      

      
        <div class="post-nav">
          <div class="post-nav-next post-nav-item">
            
              <a href="/2019/09/08/%E5%BC%A0%E4%B8%9C%E6%98%9F%E6%98%86%E6%98%8E%E5%BE%AE%E5%88%9B%E6%8B%94%E7%89%99%E7%8F%AD-2019%E5%A4%8D%E8%AE%AD-%E7%AC%94%E8%AE%B0/" rel="next" title="张东星昆明微创拔牙班(2019复训)笔记">
                <i class="fa fa-chevron-left"></i> 张东星昆明微创拔牙班(2019复训)笔记
              </a>
            
          </div>

          <span class="post-nav-divider"></span>

          <div class="post-nav-prev post-nav-item">
            
              <a href="/2019/09/13/%E3%80%8A%E5%BE%AE%E5%88%9B%E6%8B%94%E7%89%99%E5%8F%8A%E5%8F%A3%E8%85%94%E9%97%A8%E8%AF%8A%E5%B0%8F%E6%89%8B%E6%9C%AF%E5%AE%9E%E7%94%A8%E5%9B%BE%E8%B0%B1%E3%80%8B%E8%AF%BB%E4%B9%A6%E7%AC%94%E8%AE%B01/" rel="prev" title="《微创拔牙及口腔门诊小手术实用图谱》读书笔记1">
                《微创拔牙及口腔门诊小手术实用图谱》读书笔记1 <i class="fa fa-chevron-right"></i>
              </a>
            
          </div>
        </div>
      

      
      
    </footer>
  </div>
  
  
  
  </article>



    <div class="post-spread">
      
    </div>
  </div>


          </div>
          


          

  
    <div class="comments" id="comments">
      <div id="lv-container" data-id="city" data-uid="MTAyMC80MTA2Mi8xNzU4Nw=="></div>
    </div>

  



        </div>
        
          
  
  <div class="sidebar-toggle">
    <div class="sidebar-toggle-line-wrap">
      <span class="sidebar-toggle-line sidebar-toggle-line-first"></span>
      <span class="sidebar-toggle-line sidebar-toggle-line-middle"></span>
      <span class="sidebar-toggle-line sidebar-toggle-line-last"></span>
    </div>
  </div>

  <aside id="sidebar" class="sidebar">
    
    <div class="sidebar-inner">

      

      

      <section class="site-overview-wrap sidebar-panel sidebar-panel-active">
        <div class="site-overview">
          <div class="site-author motion-element" itemprop="author" itemscope itemtype="http://schema.org/Person">
            
              <img class="site-author-image" itemprop="image"
                src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/tx.jpg"
                alt="" />
            
              <p class="site-author-name" itemprop="name"></p>
              <p class="site-description motion-element" itemprop="description"></p>
          </div>

          <nav class="site-state motion-element">

            
              <div class="site-state-item site-state-posts">
              
                <a href="/archives/%20%7C%7C%20archive">
              
                  <span class="site-state-item-count">452</span>
                  <span class="site-state-item-name">日志</span>
                </a>
              </div>
            

            
              
              
              <div class="site-state-item site-state-categories">
                <a href="/categories/index.html">
                  <span class="site-state-item-count">29</span>
                  <span class="site-state-item-name">分类</span>
                </a>
              </div>
            

            
              
              
              <div class="site-state-item site-state-tags">
                <a href="/tags/index.html">
                  <span class="site-state-item-count">544</span>
                  <span class="site-state-item-name">标签</span>
                </a>
              </div>
            

          </nav>

          

          

          
          

          
          

          

        </div>
      </section>

      

      

    </div>
  </aside>


        
      </div>
    </main>

    <footer id="footer" class="footer">
      <div class="footer-inner">
        <div class="copyright">&copy; <span itemprop="copyrightYear">2021</span>
  <span class="with-love">
    <i class="fa fa-user"></i>
  </span>
  <span class="author" itemprop="copyrightHolder">本站版权归赵瑜敏所有，如欲转载请与本人联系。</span>

  
    <span class="post-meta-divider">|</span>
    <span class="post-meta-item-icon">
      <i class="fa fa-area-chart"></i>
    </span>
    
      <span class="post-meta-item-text">Site words total count&#58;</span>
    
    <span title="Site words total count">1225.8k</span>
  
</div>









<div>
  <script type="text/javascript">var cnzz_protocol = (("https:" == document.location.protocol) ? " https://" : " http://");document.write(unescape("%3Cspan id='cnzz_stat_icon_1275447216'%3E%3C/span%3E%3Cscript src='" + cnzz_protocol + "s11.cnzz.com/z_stat.php%3Fid%3D1275447216%26online%3D1%26show%3Dline' type='text/javascript'%3E%3C/script%3E"));</script>
</div>

        







  <div style="display: none;">
    <script src="//s95.cnzz.com/z_stat.php?id=1275447216&web_id=1275447216" language="JavaScript"></script>
  </div>



        
      </div>
    </footer>

    
      <div class="back-to-top">
        <i class="fa fa-arrow-up"></i>
        
      </div>
    

    

  </div>

  

<script type="text/javascript">
  if (Object.prototype.toString.call(window.Promise) !== '[object Function]') {
    window.Promise = null;
  }
</script>









  












  
  
    <script type="text/javascript" src="/lib/jquery/index.js?v=2.1.3"></script>
  

  
  
    <script type="text/javascript" src="/lib/fastclick/lib/fastclick.min.js?v=1.0.6"></script>
  

  
  
    <script type="text/javascript" src="/lib/jquery_lazyload/jquery.lazyload.js?v=1.9.7"></script>
  

  
  
    <script type="text/javascript" src="/lib/velocity/velocity.min.js?v=1.2.1"></script>
  

  
  
    <script type="text/javascript" src="/lib/velocity/velocity.ui.min.js?v=1.2.1"></script>
  

  
  
    <script type="text/javascript" src="/lib/fancybox/source/jquery.fancybox.pack.js?v=2.1.5"></script>
  


  


  <script type="text/javascript" src="/js/src/utils.js?v=5.1.4"></script>

  <script type="text/javascript" src="/js/src/motion.js?v=5.1.4"></script>



  
  


  <script type="text/javascript" src="/js/src/affix.js?v=5.1.4"></script>

  <script type="text/javascript" src="/js/src/schemes/pisces.js?v=5.1.4"></script>



  
  <script type="text/javascript" src="/js/src/scrollspy.js?v=5.1.4"></script>
<script type="text/javascript" src="/js/src/post-details.js?v=5.1.4"></script>



  


  <script type="text/javascript" src="/js/src/bootstrap.js?v=5.1.4"></script>



  


  




	





  





  
    <script type="text/javascript">
      (function(d, s) {
        var j, e = d.getElementsByTagName(s)[0];
        if (typeof LivereTower === 'function') { return; }
        j = d.createElement(s);
        j.src = 'https://cdn-city.livere.com/js/embed.dist.js';
        j.async = true;
        e.parentNode.insertBefore(j, e);
      })(document, 'script');
    </script>
  












  





  

  

  

  
  

  

  

  

  
</body>
</html>
